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Clinical outcome of transarterial embolization for postgastrectomy arterial bleeding

Authors
 Kichang Han  ;  Bestun Mustafa Ahmed  ;  Man-Deuk Kim  ;  Jong Yun Won  ;  Do Yun Lee  ;  Gyoung Min Kim  ;  Joon Ho Kwon  ;  Sung Il Park  ;  Sung Hoon Noh  ;  Woo Jin Hyung 
Citation
 Gastric Cancer, Vol.20(5) : 887-894, 2017 
Journal Title
 Gastric Cancer 
ISSN
 1436-3291 
Issue Date
2017
Keywords
Embolization ; Gastrectomy ; Gastric carcinoma ; Hemorrhage ; Infarction
Abstract
BACKGROUND: The aim of this study was to retrospectively investigate the feasibility and safety of transcatheter arterial embolization in the management of postgastrectomy arterial bleeding. METHODS: Between January 2004 and July 2015, 13,246 patients underwent total or subtotal gastrectomy at our institution, and 24 patients (18 men; mean age 66.8 years; range 42-80 years) underwent transcatheter arterial embolization for postoperative arterial bleeding identified on angiography. RESULTS: Postgastrectomy arterial bleeding occurred after subtotal gastrectomy in 14 patients (58%) and after total gastrectomy in 10 patients (42%), after a mean of 17 days (range 1-57 days). It manifested itself as luminal bleeding in 10 patients and as abdominal bleeding in 14 patients. Technical success was achieved in all 24 patients (100%). The clinical success rate was 79% (19-24); there were three transcatheter-arterial-embolization-related major complications that resulted in death within 30 days (12%), one case of recurrent bleeding, and one case of persistent bleeding. The cause of death included infarctions in the spleen and/or remnant stomach (n = 2) and bowel perforation (n = 1). The commonest bleeding focus was the gastroduodenal artery (46%, 11 patients), followed by the splenic artery (29%, 7 patients). By surgery type, the gastroduodenal artery was the commonest site of bleeding in subtotal gastrectomy (64%, 9/14) and the splenic artery was commonest site of bleeding in total gastrectomy (50%, 5/10). CONCLUSIONS: Transcatheter arterial embolization demonstrated high technical and clinical success rates with an acceptable complication rate in the management of postgastrectomy arterial bleeding. However, transcatheter arterial embolization may not be the best treatment option in patients who have undergone subtotal gastrectomy and bled from the splenic artery owing to the high risk of infarctions of the remnant stomach and the spleen.
Full Text
https://link.springer.com/article/10.1007%2Fs10120-017-0700-2
DOI
10.1007/s10120-017-0700-2
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kwon, Joon Ho(권준호) ORCID logo https://orcid.org/0000-0002-6178-7252
Kim, Gyoung Min(김경민) ORCID logo https://orcid.org/0000-0001-6768-4396
Kim, Man Deuk(김만득) ORCID logo https://orcid.org/0000-0002-3575-5847
Noh, Sung Hoon(노성훈) ORCID logo https://orcid.org/0000-0003-4386-6886
Park, Sung Il(박성일)
Won, Jong Yun(원종윤) ORCID logo https://orcid.org/0000-0002-8237-5628
Han, Ki Chang(한기창) ORCID logo https://orcid.org/0000-0002-9701-9757
Hyung, Woo Jin(형우진) ORCID logo https://orcid.org/0000-0002-8593-9214
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URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/154732
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